NCC242910_FRO Submitted_20240920

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
O EROSION & SEDIMENTATION CONTROL
IREDELL No person may initiate any land-disturbing activity on one or more acres, Yz acre or more inside a
COUNTY NC watershed, as covered by the Sedimentation Pollution Control Act and the Iredell County Land
_ _ Development Code, before an acceptable erosion and sedimentation control plan has been submitted
and approved by the lredell County Planning&Development, Erosion Control Section.
(Please type or print)
Part A.1. Project Name Lo7 /7 L i
E T/e/� �l�/#7ecs /'f►
2. Location of land-disturbing activity: County heeele/l City or Township /foam:1 41/e
Highway/Street(./5ly(/6/4 1Q.Latitude Longitude
4/44
3. Approximate date land-disturbing activity will commence: ,4 (� 2toz
4. Purpose of development(residential,commercial, industrial, institutional, etc.): Co/fr91YJerCJ/fG
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): atgAgg .1.7o etC.•
6. Amount of fee enclosed:$ 356. Olo . An application fee of$175.00 per acre(rounded up to the next acre)is
assessed without a ceiling amount (Example: a 8.10-acre application fee is $1575). For projects > than 0.5 acres but no
greater than 0.99 acres in a water supply watershed, a flat fee of$100.00 is assessed.
7. Has an erosion and sediment control plan been filed? Yes No Enclosed
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
NNaamme1/3eiry Ve_cA-adc�$ E-mail Address C•=/5Z7C 9/019-/L N.Co7
Ce-
Telephone.' /34-5.6,70 �9�eit '-' Fax# /✓///4'
9. Landowner(s)of Record(attach accompanied page to list additional owners):
CA-yv'9.9 Dive, Ge-c
Name Telephone Fax Number
//7 Cross/Age 9rk OR. //11.
Current Mailing Address Current Street Address
Noace &',/lam ,Ic 2$/L7 A/A7_
City State Zip City State Zip
10. Deed Book No. ZZZCO Page No. Z32/ Provide a copy of the most current deed.
Part B.
1. Person(s)or firm(s)who are financially responsible for the land-disturbing activity(Provide a comprehensive list of all
responsible parties on an attached sheet):
CAyvYr4 7xide ct c J On 1 von e F,,,. it. .
Name E-mail Address
//7 £ osslevie aric De. 93,E 5ionk Ave,- Aye.
Current Mailing Address Current Street Address
frkotes✓a NC 28//7 3i'onX Ny /o+73-49oc
City State Zip City State Zip
Telephone)CPO)B&/" 1400 Fax Number / 4/'
Page 1 of 2

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2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address of the designated
North Carolina Agent:
. fri- 42/e' feereaVeccik!� 7D0m e a Idleo"7mg 41 AC0,,i
Name E-mail Address
/17 Cioss/*gc f3r14 PA . 04
Current Mailing Address Current Street Address
/Pl eith/°1 it/C. 24117 /i-
City State Zip . City .State Zip
Telephone Fax Number 404-
(b)If the Financially Responsible Party is a Partnership or other person engaging in business under an assumed name, attach
a copy of the Certificate of Assumed Name. If the Financially Responsible Party is a Corporation, give name and street
address o Registe • ,
1— 4
Name egistered Agent E-mail Address
Current Mailing Address • Current Street Address
City State Zip City State Zip
Telephone Fax Number
The above information is true and correct to the best of my knowledge and belief and was provided by me under oath (This form
must be signed by the,Financially Responsible Person if an individual or his attorney-in-fact, or if not an individual,.by an officer,
director,*partner, or registered agel4 with the authority to execute instruments for the Financially Responsible Person). I agree"to
provide corrected information'should there by any change in the information provided herein.
Type or print name Title or Authority
Signature Date
I, Meat
toy a Notary Public of the County of +�i�eol
•
State of North Carolina, hereby certify that ilirkiC• ferregPC.c hio appeared personally before me this day
and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal,this Oh day of V , 20
``�►tlltlllff�I� Notary
.; .,,3 ez 04 iss/o/% ..-Cee. My commission expires ib•»bS ZOZ
��CC33''NOTA9ek,�
01 �UaUO /0 " ..
'';4COUN N� . .
hill!!+�
Page 2 of 2

� AMENDED LIMITED LIABILITY COMPANY ANNUAL REPORT 17"4".")
T
116/262
NAME OF LIMITED LIABILITY COMPANY: Cayuga Drive, LLC
Filing Office Use Only
SECRETARY OF STATE ID NUMBER: 1301914 STATE OF FORMATION: NC
AMENDING DOC ID
REPORT FOR THE CALENDAR YEAR: # ❑ , i CI
SECTION A:REGISTERED AGENTS INFORMATION 0 Changes
1.NAME OF REGISTERED AGENT: Jonathan Loonin �w�•
2.SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3.REGISTERED AGENT OFFICE STREET ADDRESS&COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
117 Crosslake Park Dr. 117 Crosslake Park Dr.
Mooresville, NC 28117 Iredell Mooresville, NC 28117 Iredell •
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: real estate
2.PRINCIPAL OFFICE PHONE NUMBER: (7,18) 861-1400 3. PRINCIPAL OFFICE EMAIL:[e-mail]
LT
4.PRINCIPAL OFFICE STREET ADDRESS 5. PRINCIPAL OFFICE MAILING ADDRESS •
935 Bronx River Ave 935 Bronx River Ave
Bronx,NY 10473-4900 Bronx Bronx, NY 10473-4900 Bronx
6. Select one of the following if applicable. (Optional see instructions)
❑ The company is a veteran-owned small business
❑ The company is a service-disabled veteran-owned small business
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SECTION C:COMPANY OFFICIALS(Enter additional company officials in Section E.)
NAME: Dominic Ferrovecchio NAME: NAME:
TITLE: Managing Member TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
935 Bronx River Ave
Bronx, NY 10473 Bronx
SECTION D:CERTIFICATION OF ANNUALBEPORT. Section D must be completed in its entirety by a person/business entity.
SIGNATURE DATE
Form a signed by a Company Official listed under Section C of This form.
Print or Type Name of Company Official Print or Type Title of Company Official
SUBMIT THIS ANNUAL REPORT WITH THE REQUIRED FILING FEE OF $10.00
MAIL TO:Secretary of State, Business Registration Division,Post Office Box 29525,Raleigh,NC 27926-0525